Dudley S. Danoff, MD, FACS
As men age, they need to keep up with their sexual health in different ways. Here are the most important tips for every decade of your life, from your twenties to your eighties and beyond.
Your twenties are the years for pursuing enhanced sexual health by following a vigorous exercise program and a diet high in protein and low in fat and carbohydrates. Pay meticulous attention to weight control by stepping on a scale every day. If you are above your target weight, eat less the next day so that your weight remains stable. Have as much safe sex as you can fit into your schedule because as you age and look back to your twenties, you will regret not having taken advantage of your youthful capabilities.
In your thirties, weight control becomes more problematic. It takes more effort to curb your appetite and keep up with a sensible fitness program. The burdens of marriage, jobs, and perhaps children can make achieving your health goals more difficult. Whether you are straight, gay, or bisexual, frequent sexual activity is a sure way to increase your cardiovascular fitness, mental acuity, inner enthusiasm, and psychological tranquility.
Beginning at age forty, all men should discuss their medical and family history with their doctor to determine if they should get a yearly PSA (prostate-specific antigen) test. This is a blood test that detects the early presence of prostate cancer. The test is controversial because a number of factors can cause an abnormal PSA. If you recently had sex or a bowel movement, frequently sit on a hard bicycle seat, or are fighting an infection, your PSA might be elevated. Unfortunately, prostate cancer can also elevate the PSA. Currently, a PSA blood screening test is the only legitimate and reliable way to diagnose prostate cancer early. The key to successfully treating aggressive prostate cancer is early diagnosis, when the tumor is confined within the prostate gland. Prostate cancer affects one in nine men throughout the lifespan, and it is the second-leading cause of cancer death in men in America. In addition to getting a PSA test, keep up your diet and fitness program, although with age you may need to modify it.
In your fifties, things get a little tougher. This is the best age to check your serum testosterone. As men age, their circulating serum testosterone decreases by approximately 1 percent a year, and many men in their fifties will feel the effects of low testosterone, such as decreased libido, loss of muscle mass, increased body fat, and depressed mood. If your testosterone is low, testosterone replacement therapy is both legitimate and encouraged. If getting or maintaining an erection is problematic, the drugs that increase blood circulation, including Viagra and Cialis, are safe and effective. These are drugs of performance and not drugs of desire, so it is up to you to keep an attitude of youthful love. The greatest aphrodisiac is love itself. Be creative, be bold, be proactive, and care passionately about the needs of your partner, and the dividends will keep accumulating.
In your sixties, take advantage of all the advances we have made in medicine, including knowledge about diet, weight control, exercise programs, cholesterol levels, and blood pressure management. Research has shown that increased sexual activity in this age group is related to increased longevity. This is the time to be more innovative in the bedroom and more adventuresome with your partner. Retirement or slowing down in your work life, with the children gone, gives more opportunity for leisure time, and what better way to spend that time than with an increase in sexual encounters? My most content patients in their sixties remain active in work and in play, both of which contribute to health. The use of drugs like Viagra and Cialis is completely safe, with the exception of patients with coronary artery disease who are taking nitroglycerine.
Let’s be frank, a seventy-year-old man in 2020 is like a fifty-year-old man in 1950. Seventy is the new fifty. Until recently, our society’s image of aging usually excluded sex. Even today, some elderly people have to sneak around to have sex, just as they did when they were teenagers, because they know their peers and children will disapprove. This generation of aging seniors is recognizing that they deserve active, healthy sex lives as long as they remain physically fit. Sex will not harm them unless they try positions their muscles and joints are too weak to manage or they overextend themselves to the point of exhaustion. In your seventies, adjust your sexual activities as your body changes and look upon the adjustment as a challenge and an opportunity. Learn to use your imagination to make up in creativity what you may lack in physical strength.
Just as in previous decades, you should also minimize your consumption of fat and cholesterol; control your weight; refrain from smoking, excessive drinking, and drugs; watch your blood pressure, and see your physician regularly. Most importantly, do not think old! Your body will produce less testosterone, your blood vessels may become partially obstructed, diminished blood flow to the penis will make getting and maintaining a good erection more challenging, and your muscles and joints may deteriorate. But if your mind is strong and your level of enthusiasm high, sexual activity can still be enormously satisfying. Think of yourself as a singer whose voice is not as powerful as it once was but who makes up for it with phrasing, feeling, and subtlety, or as an athlete or a dancer whose legs are no longer as strong as oaks but who performs with added grace, shaped by the wisdom of experience. If you keep your enthusiasm, you can compensate for or even delay the effects of aging.
More Americans are in their eighties, nineties, and even hundreds than ever before, and their numbers are increasing dramatically. Luck and good genes are the key factors that determine your degree of sexuality at this stage in life. If you are fortunate to be genetically blessed and lucky enough to avoid physical catastrophe, you can still be sexually active with a caring and understanding partner. It may take more sensitivity, compassion, and patience, both inside and outside the bedroom, but satisfying sex is still possible. The drugs that improve penile blood flow (such as Cialis and Viagra), injectable medicines that increase blood flow (like Prostaglandin E1), vacuum erectile devices, and even surgical implants are all possibilities for the motivated and enthusiastic members of the supersenior set. The future bodes well for the sex lives of patients now entering their senior years.
In sports, what were once considered insurmountable barriers, like the four-minute mile and the seven-foot high jump, are now accomplished routinely. The peak years of athletes have been dramatically extended. So there is no reason why the years of active sexuality cannot be similarly extended as we look to 2020 and beyond.
Dudley Seth Danoff, MD, FACS, is president and founder of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, a Diplomate of the American Board of Urology, a Fellow of the American College of Surgeons, and the author of The Ultimate Guide to Male Sexual Health.